Study: Alternatives to Methadone Work

— The first head-to-head comparison of treatments for heroin
addiction found that two newer, easier-to-take medicines work just
as well as methadone, the standard drug since the 1960s.

Unlike methadone, which has to be taken daily, the two other
drugs are longer-acting and can be taken only three times a week.

Previous studies have shown all three medications — methadone,
Orlaam and buprenorphine — to be effective in treating heroin
addiction. This study looked at them together for the first time.
The findings were published in Thursday’s New England Journal of
Medicine.

Two Rather Than One

The two newer drugs could improve treatment of heroin addiction
by giving doctors more options, said researcher Rolley E. Johnson
of Johns Hopkins University School of Medicine, who led the study.

“There are some patients who perhaps have tried methadone and
didn’t think it was the thing that could help them. They may
benefit from [Orlaam] or they may benefit from buprenorphine. Maybe
we can get those people back into treatment,” said Johnson, who
has worked as a consultant for makers of all three medications.

Methadone, a synthetic narcotic, has been used for more than 30
years to treat heroin addiction. It suppresses withdrawal symptoms
and curbs the craving for heroin.

Orlaam, another synthetic narcotic known generically as
levomethadyl acetate, was approved in 1993 but has not been widely
used. Buprenorphine, also a synthetic narcotic, is awaiting
approval from the Food and Drug Administration for use as an
anti-addiction drug. It causes weaker narcotic effects.

Methadone and Orlaam are liquids, while buprenorphine will be
marketed as a tablet. But all three drugs were given in liquid form
during the study so that participants would not know what they were
getting.

Different Options for Treatment

There are about 1 million chronic heroin users by government
estimates, said Alan I. Leshner, director of the National Institute
on Drug Abuse, which paid for the research. He said the findings
point to more options for doctors and ways of treating more
patients.

“We need, like any illness, to have an array of treatments in
the clinical toolbox,” Leshner said.

To test the three medications, researchers at Johns Hopkins
recruited 220 heroin addicts and treated them for 17 weeks in
1996-97. The patients were given one of the three medications — Orlaam or buprenorphine three times a week, or a high dose of
methadone daily. A fourth, control group was treated with a low
dose of methadone each day.

Researchers tracked the patients’ continued use of heroin, and
the participants graded the severity of their drug problem.

Variety of Treatments Helped

High-dose methadone and the two newer medications were all
effective in treating heroin addiction, and all worked
significantly better than low-dose methadone. Patients in all four
groups reported a 90 percent drop in heroin use when they began
treatment.

High-dose methadone was the best at keeping patients in
treatment: an average of 105 days out of 119. Orlaam was the best
at keeping patients away from heroin; 36 percent of that group
tested negative for heroin use for a month or longer.

No serious side effects were reported for any of the medicines.
Participants complained of such things as constipation, nausea and
dry mouth.

Johns Hopkins said it pays $3.15 a week for methadone and $13.60
a week for Orlaam. Buprenorphine is expected to cost more than
Orlaam.

Johnson said recent federal legislation will allow doctors in
office-based practices to prescribe buprenorphine once it is
approved by the FDA. The more tightly controlled methadone and
Orlaam are now dispensed through heavily regulated clinics only.

Methadone treatment is not even available in six states — Idaho,
Mississippi, Montana, North Dakota, South Dakota and West Virginia
— according to the Lindesmith Center-Drug Policy Foundation, a New
York-based institute that advocates drug policy reform.